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June 27, 2023

Rep. Schiff and Sen. Smith Introduce the PrEP Access and Coverage Act

Washington, DC — Today, Congressman Adam Schiff (D-Calif.) and Senator Tina Smith (D-Minn.) reintroduced the PrEP Access and Coverage Act to eliminate out-of-pocket costs and other barriers to access for PrEP and PEP – two lifesaving HIV prevention medications.

“HIV prevention drugs shouldn’t be inaccessible and unaffordable. Senator Smith and I are reintroducing the PrEP Access and Coverage Act so that LGBTQ Americans – especially those from communities of color who experience disparities in health care – have access to the HIV medications and services they need,” said Rep. Schiff.

“Every person deserves access to affordable, high quality health care,” said Sen. Smith. “Too many people in Minnesota and across this country are unduly burdened by the high costs of HIV prevention drugs, and many others are going without this lifesaving preventative medication. This bill takes an important step towards ensuring that these highly effective medications are accessible and affordable for every patient who needs them.”

“To end the HIV epidemic by 2030, we must expand our efforts to improve PrEPeducation and access,” said Torrian L. Baskerville, Director of HIV & Health Equity for the Human Rights Campaign Foundation. "It is especially critical toaddress decades-long inequities that disproportionately impactBlack and Latine LGBTQ+ communities by guaranteeing equitable insurance coverage for preventive services, mandated in the same manner as life-saving treatment. We believe the PrEP Access and Coverage Act is a clear step in the right direction towards increasing access and placing a permanent halt to the HIV epidemic.The Human Rights Campaign thanks Senator Tina Smith and Representative Adam Schiff for their continued leadership on this issue.”

“We thank Sen. Smith, Rep. Schiff, and their colleagues for their leadership in re-introducing the PrEP Access and Coverage Act,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Passage of this bill will greatly expand access to PrEP for those who have health coverage across all payers, and create a national PrEP program that includes community and provider outreach, as well as PrEP drugs and associated services for the uninsured. Recognizing that many current PrEP users with private insurance are being wrongfully charged cost-sharing, we are pleased that the bill has been revised to include a new compliance and enforcement section.”   

To address these inequities, the PrEP Access and Coverage Act would ensure comprehensive coverage and eliminate out-of-pocket costs for PrEP and PEP for individuals who are enrolled in health plans through the Affordable Care Act Marketplace, Medicare, Medicaid, TRICARE and employer-sponsored insurance. This legislation also takes steps to ensure access to PrEP and PEP for uninsured individuals by providing grants to states, territories, Tribes, and health care facilities, such as Federally Qualified Health Centers and family planning centers, to establish and support programs that ensure access to PrEP and PEP in underserved communities.

The PrEP Access and Coverage Act would:

  • Ensure comprehensive health insurance coverage of HIV prevention medications by eliminating out-of-pocket costs for the medication and associated costs, including lab fees, for individuals who are enrolled in federally regulated private and public health insurance plans (including Medicaid, Medicare, CHIP, and TRICARE).
  • Prohibit prior authorization requirements for HIV prevention medication under private and public health insurance plans.
  • Prohibit denying coverage or increasing premiums for disability insurance, long-term care insurance, or life insurance policies based on a person taking medication for HIV prevention.
  • Direct the Department of Health and Human Services (HHS) Secretary to establish public health education campaigns to increase utilization of PEP and PrEP among individuals at risk of contracting HIV.
  • Establish a grant program for States, Territories, Tribes, and health care facilities, such as Federally Qualified Health Centers and family planning centers, to expand access to PrEP and PEP for uninsured individuals and underserved communities.
  • Direct relevant federal agencies to support implementation and ensure compliance of the PrEP and PEP coverage requirements established under this legislation. 

The legislation is endorsed by the American Academy of Family Physicians (AAFP), Whitman-Walker Institute, Color Health, LGBTQ Task Force Action Fund, the Human Rights Campaign, the HIV+Hepatitis Policy Institute, the National Center for Lesbian Rights, and the AIDS Institute.

It is co-sponsored in the House by Representatives Nydia M. Velázquez (D-N.Y.), Lloyd Doggett (D-Texas), Jim McGovern (D-Mass.), Bill Pascrell Jr. (D-N.J.), Barbara Lee (D-Calif.), Betty McCollum (D-Minn.), Stephen F. Lynch (D-Mass.), Raúl M. Grijalva (D-Ariz.), Gwen Moore (D-Wis.), Debbie Wasserman Schultz (D-Fla.), Steve Cohen (D-Tenn.), Hank Johnson (D-Ga.), André Carson (D-Ind.), Gerry Connolly (D-Va.), Chellie Pingree (D-Maine), Mike Quigley (D-Ill.), Judy Chu (D-Calif.), Terri Sewell (D-Ala.), Dina Titus (D-Nev.), Ami Bera (D-Calif.), Jared Huffman (D-Calif.), Mark Pocan (D-Wis.), Mark Takano (D-Calif.), Don Beyer (D-Va.), Seth Moulton (D-Mass.), Norma Torres (D-Calif.), Bonnie Watson Coleman (D-N.J.), Dwight Evans (D-Pa.), Salud Carbajal (D-Calif.), Adriano Espaillat (D-N.Y.), Josh Gottheimer (D-N.J.), Pramila Jayapal (D-Wash.), Jimmy Panetta (D-Calif.), Jimmy Gomez (D-Calif.), Mary Gay Scanlon (D-Pa.), Susan Wild (D-Pa.), Sean Casten (D-Ill.), Sharice Davids (D-Kan.), Madeleine Dean (D-Pa.), Jesús “Chuy” García (D-Ill.), Sylvia R. Garcia (D-Texas), Joe Neguse (D-Colo.), Katie Porter (D-Calif.), Greg Stanton (D-Ariz.), Haley Stevens (D-Mich.), David Trone (D-Md.), Lauren Underwood (D-Ill.), Jamaal Bowman (D-N.Y.), Cori Bush (D-Mo.), Sara Jacobs (D-Calif.), Marilyn Strickland (D-Wash.), Ritchie Torres (D-N.Y.), and Eleanor Holmes Norton (D-Washington, DC).

Additional Background:

PrEP (Pre-exposure prophylaxis) is a daily prescription medication that dramatically reduces the risk of HIV infection. PEP (post-exposure prophylaxis) is an antiretroviral medication prescribed to HIV-negative patients immediately following a specific high-risk exposure to HIV that can reduce the odds of transmission. Together, these highly effective medications can help stop the spread of HIV, and it is critical that they are accessible and affordable for every patient who needs them.

These life-saving drugs are underutilized by the communities that need them most.  This is partially driven by limited access to health insurance that covers PrEP, PEP, or the necessary tests and follow-up visits associated with these medications. This has resulted in significant disparities among those who are recommended to take PrEP or PEP, and those who are prescribed the medication. According to the Centers for Disease Control and Prevention (CDC), in 2016, white individuals made up 26 percent of those who are considered at-risk for contracting HIV, yet they made up over 68 percent of those who received PrEP prescriptions that year.  Black individuals accounted for 43 percent of high-risk individuals but made up only 11 percent of PrEP users. Similarly, Hispanic individuals accounted for 13 percent of prescriptions despite making up nearly 25 percent of those considered high-risk. 

The full bill text can be found here.